Financial Clearance Specialist - Remote

📋 Description

• • Serve as the first point of contact for patients scheduled for medical services at UMass Memorial Health, ensuring every individual feels welcomed, informed and financially prepared before care begins. You will embody the organization’s belief that “everyone is a caregiver,” delivering compassionate, accurate guidance that directly impacts patient experience and access to care.
• • Own the end-to-end financial clearance workflow for a high-volume caseload, proactively initiating contact with commercial, Medicare, Medicaid and self-pay patients at least 48–72 hours prior to service. You will verify demographics, insurance eligibility, benefits, authorizations, referrals and out-of-pocket estimates, documenting every interaction in clear, concise notes within Epic and the Financial Clearance module.
• • Calculate and communicate precise patient financial liability—including copayments, deductibles, coinsurance and deposits—using real-time payer data and UMass Memorial’s estimation tools. You will confidently explain complex billing concepts in plain language, answer questions and negotiate payment plans or prompt-pay discounts when appropriate, always adhering to the Financial Clearance Policy and Standards of Respect.
• • Collect point-of-service payments via cash, check, credit card, HSA/FSA or online portal, posting transactions accurately and issuing receipts. You will reconcile daily deposits, research discrepancies and escalate unresolved balances to the Business Office or Financial Counselors while maintaining strict PCI compliance and confidentiality.
• • Secure pre-certification, prior authorization and referral numbers from insurance carriers, physician offices and ancillary departments, tracking approval status and rescheduling appointments when coverage gaps or financial barriers are identified. You will act as a liaison between patients, providers, schedulers and payers to prevent delays, denials and surprise bills.
• • Identify patients who qualify for financial assistance, charity care, MassHealth or hospital-sponsored payment plans, warmly transferring them to Financial Counselors and following up to ensure applications are completed before service dates. You will maintain a working knowledge of federal, state and payer-specific regulations, including HIPAA, EMTALA, No Surprises Act and payer medical-necessity criteria.
• • Leverage Epic, Cerner, Experian, payer portals and Microsoft Office to generate reports, monitor clearance rates and flag trends in denials or underpayments. You will participate in daily huddles, weekly KPI reviews and monthly training sessions to continuously improve accuracy, productivity and patient satisfaction.
• • Demonstrate agility in a fast-paced, metrics-driven environment, reprioritizing tasks as schedules change, emergencies arise or payer policies update. You will handle 60–80 patient accounts per day with an average talk time under six minutes while maintaining a 95 % first-call resolution rate and a 98 % accuracy score.
• • Champion a culture of respect by acknowledging patient concerns, listening actively, communicating transparently and responding promptly to voicemails, emails and chat messages. You will celebrate small wins with teammates, share best practices and mentor new hires, reinforcing UMass Memorial’s mission of healing and community service.
• • Perform additional duties as assigned—such as overflow registration, insurance verification for walk-ins, or special projects during system upgrades—to ensure seamless department operations and an exceptional patient experience every day.